One Some Species in the Museum of Pathology of the Faculty of Medicine at Coimbra University

On some Specimens in the Museum of Pathology of the Faculty of Medicine at Coimbra University

Daniel Cartucho1,2

1. Serviço de Cirurgia II - Centro Hospitalar Universitário Algarve 2 . Algarve Biomedical Centre (ABC)

dcartucho@gmail.com

Abstract

Traditionally, pathology museums served the purpose of being a part of the educational program of the Faculties of Medicine as an example of the teaching of a certain disease. The fascination provoked in students was largely a measure of making them conscious that they were entering a peculiar and frankly different world that was unknown to them up until that point. Simultaneously, in the face of the diversity observed and limited medical understanding, there is a strong incentive to investigate this world of medicine. The use of photography in illustrating historical medicine with images is not novelty. Presently, the extent to which our existence depends upon images in a world bound together by visual communication is undeniable: photographs are often credible sources of illustrating the past as well as a widely accepted communication device in the present, and can be an important reference for future generations. The author refers to his experience as a student where he recorded a photographic memoir which reflects the reality of a period and concludes with comments on the present role of Pathology Museums today.

Keywords:

History of Medicine; Museum of Pathology; Wax model.

Figure 1. Aspect of the Museum of Pathology, Faculty of Medicine, University of Coimbra, around 1980.

Introduction

The Museum of Pathology of the Faculty of Medicine of the University of Coimbra was, for students of the 1980s, simultaneously hardly ccessible due to restricted access to the museum by the nature of the exposed material, and a place of fascination. It was a place where a student was confronted with rare and unique samples which exposed the rawness of a particular disease process and in its unique diversity, creating a framework for a different world, the world of medicine.

This fascination led me in later stages, with the consent of the Director at that time, Prof. Doutor Matos Beja, to create a photographic register of this medical collectanea now published in this journal as: Historical Images in Medicine. Every image or memory requires a physical setting, a space in which it took place1. Clearly, the museum physically looked to be of the 1980’s.

Along with the descriptive text of the collection of specimens on display in the Museum was a historical reference to the location to which the photographs took place.

This option had the pretence not only capture the specimen but to frame the images in their respective places in the Museum. Photographers attempt to capture the sense of the place in any one image. Every image or memory requires a physical setting, the object and the space it occupies must be clearly captured. Some subjectivity can exist, resulting from attempts to illustrate the sense of the place.

The sentiment that emerges immediately from the Museum is the permanent need to investigate in medicine. Such pathological diversity gives us an immense dimension of the lack of knowledge we still feel about the human body and in a laxer form, life itself.

Figure 2. Cabinet with osteoarticular pathology. In the collection of skeletal specimens there are a series of diseases in an almost complete collection of the most frequent anomalies (Cruveillier) of Consistence and Continuity. “Deficiency and excess of development. The entire bony fabric of the body has disappeared and in a few cases are of monstrous proportions. Even, in some individuals whose development, in other respects, was quite natural. A partial deficiency of the skeleton is less frequently observed, as it occurs in various parts of the body where development generally has been arrested; in the thorax, for instance, and the pelvis, and especially in the limbs. There is very commonly no bone in supernumerary peripheral parts, whether fingers, toes, or limbs.”16

History of the Museum

The history of the Museum of Pathological Anatomy of the Faculty of Medicine of Coimbra University goes back to the Portuguese Pombaline period, succeeding the existing Office of Pathological Anatomy, installed in the Museum building - Largo de S. Jerónimo - which according to Professor Renato Trincão, was mistaken for the history of the chair of Pathological Anatomy of the Faculty 2. It was from the collection of pathological samples, prepared by Dr. Carlos José Pinheiro, that the rudiments of the first museum of Pathological Anatomy was inaugurated at Coimbra University in Portugal, in 1863. Installed in the Faculty of Medicine, during the period of the Corporative political system, the Museum was 500 square meters and had XIII displays, maintaining 1000 specimens in formyl, air dried, wax models, books and photographs 3 .

It was in 1863, “although the first collection was without doubt small, it already had existed since 1822, as was demonstrated by the scientific inventory of the specimens prepared in the Anatomical Theatre of Coimbra University”, in which 41 of the 158 specimens catalogued, were of anatomo-pathological origin2 .

Figure 3. Detail of exposed parts with osteoarticular pathology. “Deficiency and Excess of Development. In cases of Acephalus, the skull has altogether disappeared, or has reduced to a mere rudimentary condition. It is liable, also, to various degrees of defect, in Acra- nia- being without any vault, and in Encephalocele and Anencephalus presenting various, but lesser degrees of the same anomaly. Defects of other parts are noticed when the cranial or facial bones are fissured, when certain portions of the brain are missing, or symetrical parts of it are fused together, as happens in Cyclopia, etc.”16

In this period, a disease was usually documented with the use of lithography. A drawing, a wax model, or preservation of the abnormality in a preserving liquid, served the purpose of contributing to the understanding of the human body in medicine.

The Museum collection contains specimens preserved over the years, showing “classical” and “rare” cases of human and animal pathologies arranged systematically by topics which we can follow through the descriptive references made by Renato Trincão on retirement in 1990, having completed the entire collection here registered. On the numerous corresponding shelves of thematic cabinets, we could see in this photographic visit, parts of the human body with noted disease, distributed by themes which we counterposed, through legend, a report of analogous disease and the form in which this was referred to in the nineteenth century, period in which growth of these museums was seen around the world.

Anomalies of Consistence and Continuity

The bone collection, includes dozens of specimens illustrating the disease of the Osseous system, including Spinal Curvatures, Arthritis Deformans, Tuberculous Arthritis, Osteomylitis, Syphilis of bone, and a remarkable specimen of malunion. Worth mentioning is a case of a complete skeleton of a clinical case of rickets and multiple cases of hydrocephalus. One case of hydrocephalus illustrates, by the size, a fairly uncommon case. Also fragments of bone tumors at the time of preparation with natural doubts over the future of their classification, were placed as differentiated specimens of osteitis.

Anomalies and monstrosity

In relation to specimens of the catalog that arrived in 1860, there were bottles of liquid preservative with six to eight “anomalies and monstrosities”. Various monsters of the sixteenth, seventeenth and eighteenth centuries are described in literature, but it is in the eighteenth century, that the relationship between the study of a monstrosity and the understanding of the regular physiological and anatomical formations of the human body is identified4. At Coimbra University, reformed under the Marquis of Pombal (1722) led to the creation of an office for Natural History of which the monstrous specimens were to become a part of its collection and referenced by its director Dominic Vandelli5 as including “a being with two heads (...) double female

Figure 4. Cabinet with anomalies and monstrosity. On the second shelf, a unitary notencefalo monster can be seen with reference in catologue published in the XIX century. Several examples of specimens of conjoined twins . “In those double monsters in which the point of junction is the thorax, that part is found developed to excess. It is perternaturally developed likewise, when there is more than the proper number of ribs. Sometimes the supernumerary rib is borne upon a thirteenth dorsal vertebra, sometimes upon the first lumbar, while, in rare cases, the seventh cervical vertebra has a rib connected with it, which may either terminate by a free extremity, or become attached to the sternum, or to the true first rib.”

fetus with four arms and four legs in a single trunk.” Vandelli in his explanation of the “generating process” noted that “the ancients until the time of Harvey (1578-1675), thought that the generation of animals was made through the intimate union of the thighs of both sexes. Others, such as Harvey (1578- 1675), Malpighi (1628-1694), Graaf (1641-1673) and Haller (1708-1777), thought there were eggs in the ovaries or that it was a system of preformation in the egg, which in Malpighi and Malebranche (1632- 1723) called the system of evolution. Another system of preformation by the authors Hartsoccker van Leewenhoek (1632-1723), had sperm as original of animals. But the findings, thanks to the microscope, of living or organic molecules or less organized living organisms, plastic forcesalthough known by another name, such as active Force or Vegetatriz, were reviewed again by Buffon (1707-1788) and Needham (1713-1781) who confirmed that Vitality is determined from the point of a resistant and expansive force. However, we can accept the ovule or the preformation in the egg; in truth the Vitality adds from the point of the resistant and expansive particles of the male seed of the germ or pre outline”. This later lead to the explanation of the origin of gestations which gave

Figure 5. Detail of exposed parts with anomalies and monstrosity. “The most striking deformity of the brain is that in which the cerebrum is single; it occurs in conjunction with cyclopia, and with partial or total absence of the face. Malformations; and anomalies in the origin, course, and branching of nerves. Anomalies in the form of the trunk of a nerve are very seldom of any importance; instances of it are met with in the olfactory nerves, which are sometimes hollow at birth; and in the optic, which are found in cyclops monsters to be single, or in various extent fused together.”

Figure 6. Another aspect of exposed parts with anomalies and monstrosity. “In these double monsters, in which the point of junction is the thorax, that part is found developed in excess. It is perternaturally developed likewise, when there is more than the proper number of ribs. Sometimes the supernumerary rib is borne upon a thirteenth dorsal vertebra, sometimes upon the first lumbar, while, in rare cases, the seventh cervical vertebra has a rib connected with it, which may either terminate by a free extremity, or become attached to the sternum, or to the true first rib.”

way to the creation of malformations and the appearance of the monster. Once presenting his explanation of pregnancy, that lead to the proposal of the creation of malformations and the appearance of the monster.

The appearance of the microscope was very important. But we must remember that before its appearance, the evolution of science was through observation as through the eyes of Amato Lusitano (1511-1568) who described the case of a woman who was said to have impregnated another (VII Centúria, cura 18). The author was keen to point out that this woman had recently been with her husband had somehow conveyed this element of male fecundity to the other woman. Amato Lusitano also had several descriptions of anomalous beings as were the cases of a pregnant woman who delivered beings that looked like frogs (I Centúria, cura 27), or of a girl who became a man (II Centúria, cura 39) or of a certain monster (III Centúria, cura 57)6. In a continued collection - inventory published in 1915 by Luis dos Santos Viegas, Catálogo do Museu de Anatomia Patológica da Universidade de Coimbra7 - a part of this collection worth mentioning is the chapter “monstrosity” made up of single unitary monsters and “double monsters”.

In the single unitary monsters, there are references to Ectromelianos, Exencefalianos, Podencefalo, Anencefalianos, anencephaly, Ciclocefalianos. In the museum display cabinets, it is possible to view some of the malformations referrred to as the so called “monsters”.

Figure 7. Aspect of exposed parts with anomalies of the face. In glass window wood cabinets, some specimens are in conserving liquid. “Cancer, and cancerous ulcer, are of frequent occurrence in the skin. Cancerous degeneration and ulceration of subcutaneous tissues very frequently involve the skin over them, and cancers of the subcutaneous cellular tissue, and of glands imbedded in it, particularly of the mammae and lymphatic glands, usually become at an early period very closely connected with the cutis. But cancer also originates in the skin, presenting itself, according to my observations, under the forms of fibrous (scirrhous), and of medullary cancer”.

Wax model collection

Dermatological and pathology wax models are an import nucleus in this Museum collection.

Wax has been used, as far back as 6.000 years ago, for anatomical representations of several purposes8. “The wax is the material of the pictures” and three-dimensional works in wax allowed the visualization of veins and nerves, the location of organs and their connections, using an infinite wealth of detailed design. Besides the great number of details reproduced by artists in this “new” dimension, the fascination was also due to the expression conferred by the sculptures, the capture of gestures and poses, that became so realistic that the work seemed to have life 8 . The use of anatomical models in medical teaching, was a current practice during the nineteenth century. According to Felice Fontana, one could learn more from models in six months than from dissecting scarce human cadavers in six years 9 .

Most molders did not allow access to their techniques nor did they leave successors with knowledge of special molding techniques. From Jules Baretta (1834- 1923), one of the most prominent molders - also was reputed to be an alchemist - there are references to his work, commenting that he coloured his molds through the layers of the wax. He invented molds and special preparations of wax which, were not passed on. He apparently never took on any apprentices. In the technique used on the sick, known as “taking molds”, “with the softness

Figure 8. Cabinet with wax models. The museum placed human specimens and wax models on shelves to illustrate the ranges of human disease. In past centuries, several different techniques were used to show anatomical and pathological features for the education of medical students. Molds, creations of wax models, until the advent of photography, were a major highlight constituting themselves as true works of art.

of a mother and an enduring patience, he places his equipment and while the [wax] substance is taking, he converses with the patient. He is interested in their condition [...] without forcing, he wins the trust of his patient, as he inspires empathy10. Later, after obtaining the mold, it was given colour.

The Museum has dozens of works of skin conditions from this molder. Some models have the number of the lesson where it was used. Besides the models above represented by J. Baretta, the Museum also has in its collection11, models with the legends designating the pathology in French. Given the historical background the original name of the pathology has ke:

Cancro encefaloide representing the right leg, Ecthyma - representing the leg; Eczema impetiginoso ; Maladies du système cutanée.Elephantiasis. Elephantiasis des árabes representing the right lower limb; Tumor eréctil - representing a liver; Tinha favosa - representing lower limb; Roseola - representing the forearm; Ichtyose - represen- ting the right thigh, Pemphigo - representing lower limb; Kysto do ovário; Degenerações orgânicas. Espécie. Osteosarcoma - representing the leg bones; Cancro encephalóide (melanico); Acné comedon - representing the arm and shoulder; Scarlatine maligna (Will)/ Dermatoses exanthemateuses Macules hematiques - representing leg; Macules hematiques representing the thigh; Pellagra, representing part of the right foot and leg; Maladies de la peau (vesicules)/Herpes phlyctenoide à l état primitif representing chest; Scarlatina simple. Scarlatina Simples (Will) ( dermatoses exenthemateuses; - Erysipéla, representing the leg; Maladies de la Peau (Vesicules)/ Varicelle à grosses vesicules/ Swimpox des Anglais/ Varicelle pustularis. Dermatoses exanthemateuses/Variété des icules)/Herpes phlyctenoide à l état primitif representing chest; Scarlatina simple. Scarlatina Simples (Will) (dermatoses exenthemateuses; - Erysipéla, representing the leg; Maladies de la Peau (Vesicules)/ Varicelle à grosses vesicules/ Swimpox des Anglais/ Varicelle pustularis.

Figure 9. Another group of wax models. From Jules Baretta, the museum has wax models of “Erythème multiforme en nappe”; Lepre maculeuse anesthésique ; Erythème polymorphe; Eczema circiné, variété disséminée; Pemphigus; Eczema; Prurigo de Hébra chez un jeune sujet; Mycosis fongoïde; Tuberculose cutanée; Lichen ruber; Pemphi[gus pruri]gineux à petites bulles/ (Hydro[a se] reine), Acne sébacée concrètre/ Psorospermose de Mr. Darier; Lentigo; Lupus erythémateux; Trichophytie circinée; Tuberculose cutanée ulcérée.

Dermatoses exanthemateuses/Variété de differentes phases de la maladie Varioloide representing forearm; Maladies de la peau (Pustules)/ Varioloide au bras et à la main (face palmaire)/Variole mitigée. Variole mitigata; Eczema representing the right leg; representing the vulvar region; Pityriasis simples sur la poitrine/ Herpes furfurecens/ Dermatoses dartreuses representing the genital region; Lepra/ Sclerodermies. Lésions plantaires representing the right foot; Variola discreta representing the leg; Eczema representing the leg; Maladies de la peau (Vesicules)/ Eczema rubrum de la jambe à une autre époque/ Herpes squamosus madidans (Alib)/ Dermatoses dartreuses; Atrophias/ Especie/Cyrrhose representing liver; Lichen Maladies de la Peau (Papules)/Lichen sur le col d’une femme de 25 ans.

Today, time has evolved and molds of full body public wax figures are best known at the London Museum of wax figures.

The litiasis colection

Geraldino Brites published in 1929, in the Journal of Technical Methods and Bulletin of the International Association of Medical Museums, a paper with a “new method of mounting calculi, where he affirms that “The preservation and mounting of calculi offers considerable difficulties. In special phosphatic calculi, either pure or containing phosphates in large quantity, are extremely difficult to preserve because of the action of air and dampness, making them fall to pieces more or less rapidly, according to the nature of the phosphate contained in them”12 .

The knowledge of these elements was important for the enrichment of the collection of biliary calculi of the Museum. This author continues with respect to the numerous and varied systems of mounting, of which we are acquainted with, none are completely satisfactory either for preservation or from an esthetic point of view. For the calculi in the Anatomopathological collection of the First Surgical Clinic of the Lisbon School Hospital (Service of Prof. Francisco Gentil), we employed a method which we believe to be original and which in our opinion reduces the disadvantages, above mentioned, to a minimum. We use a thick-walled glass tube with round bottom, of a diameter proportional to the sum of the calculus and of a sum of the form length with the others forming the collection. A cork is prepared so that when applied to the tube it shall project slightly out of the mouth and to the inner end and thus cork a wad of cotton wool that is fastened larger or smaller according to the height at which it is decided to place the calculus. After carefully cleaning the tube with water and alcohol, the calculus is put into it and the mouth immediately closed with the cork leaving between the cork and the side of the tube a thin slip of card or thick paper bearing the number of the specimen. Now on a plate of polished glass covered with Vaseline, let 4 metal rulers be placed, heavy enough not to be easily moved”. This transcript corresponds to what we see in the pictures with the bell jar to serve as protection for certain types of calculi.

Figure 10. Collection of wax models with a wide variety of pathologies. Pemphigus, wax figures, representing the right leg, mounted on wood panel; Acne Comedonica, wax figures, representing the arm and shoulder, mounted on wood panel; erythémateux Lupus, wax figures, representing anterior chest wall, fixed on panel wood; Psoriasis palmaire, wax figures, representing the palm of his left hand, mounted on wood panel; Pityriasis versicolor, wax figures, representing anterior chest wall, mounted on wood panel.

The role of the Museum today

It is well known that Pathology Museums can be used to facilitate learning by the concrete presence of the disease as a motive for study. Today, just as in the past, this understanding is not always well acknowledged. Regarding the importance of museums at the turn of the nineteenth century to the twentieth century, we can read in the proceedings of the First meeting of the International Association of Medical Museums: “The important functions of the Medical Museum as a compendium of scientific facts, a storehouse of material for research-work, and as a teaching medium are, on this continent especially, comparatively little appreciated. (...) Here, as in all other departments, organization is the key to bringing the Medical Museum to the height of its development”13 . This Museum of Pathology, as other science museums, show mechanisms of perception and representation in medicine and specifically on disease in an historical framework, permitting immediate confrontation with an historical era where mankind faced some diseases which today have become almost non-existent.

In the case of the Museum of Pathology in the Faculty of Medicine of the University of Coimbra part of its collection, here referred to, have multiple possible approaches to the natural evolution of diseases that today, with present effective treatment options, are not allowed to evolve to such extreme forms of the disease.

Figures 11, 12. Aspects of biliary lithiasis, where its diversity is evident The collection of this museum is very rich in biliary calculus. It contains numerous calculi mounted or suspended in boxes at that time where, diversity in form, amount and composition of gallstones, is evident

Figure 13. Another aspect of lithiasis with a large bladder stone prominent. In this era, the documentation of a disease was with a drawing, lithography, a wax model or self preservation of the abnormality in a preserving liquid, in comparison to today in the era of the photography. It served the purpose of contributing to the understanding of the human body in medicine. “The importance of the medical museum in the teaching of medicine cannot be over-estimated, but such museums have been sadly neglected by the present generation of medical teachers in the United States, at least. Not one of the betterclass medical schools has any museum worthy of it. The valuable collections of our predecessors, while consisting largely of anatomical preparations, bones, monsters and other spectacular specimens, have been allowed to disappear as the result of neglect and indifference, and nothing better has taken their place.”17

In recent years the great advances in information technology and web-based learning are currently at play in every level of medical training. Some medical schools in their museums’ train paths with an introduction to technologies in augmented reality (AR). Medical schools that have considered the contents of their museums as irreplaceable resources for modern medicine and medical education, consequently, have updated their medical museums and equipped them with new technologies 14 .

With disease models these museums possess to work with, an introduction to the AR technologies can support the best of both worlds which together can serve the objective of increasing the interest in biological and biomedical research activities. In the case of AR, the number of applications from these models from these museums is immense and in fact already exists 15 . As a final comment in this trip around the use of photography in a Museum of Pathology, a record of images in Historical Medicine we can say that the extent to which our existence depends upon images in a world bound together by visual communication is undeniable: photographs are often credible sources of illustrating the past as well as a widely accepted communication device in the present, and can be an important reference for future generations1. To those who might be interested in this Museum, it is open to public in the terms described in the website of the Museum of Science- University of Coimbra. The tours that are periodically scheduled, are guided, and entry is free.

Figure 14. Detail of exposed parts with cataract collection.

Figure 15. Hairpin from Private Clinic The Hairpin from Private Clinic - 1904. A hairpin taken from the urinary blader of a woman of 22 years, extraction through the urethra on 02/05/1904. Delay of the hook in the bladder 5 days.

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